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Comparison of long-term mortality across the spectrum of acute coronary syndromes.
Am Heart J. 2006 May; 151(5):1065-71.AH

Abstract

BACKGROUND

Data are sparse regarding comparative long-term mortality across the spectrum of patients presenting with acute coronary syndrome (ACS).

METHODS

We identified all patients hospitalized with suspected myocardial ischemia in an urban academic hospital from 1991 to 1992. We compared presenting characteristics, treatment, and long-term mortality between patients with unstable angina (UA), minor myocardial damage (MMD), definite non-ST-elevation myocardial infarction (NSTEMI), and STEMI.

RESULTS

Of 760 patients (mean age 68 years, 35% women), 22% had UA, 35% had MMD, 26% had NSTEMI, and 17% had STEMI. During a mean follow-up of 9.5 years, unadjusted mortality was highest in patients with MMD and NSTEMI (mortality for UA 43%, MMD 68%, NSTEMI 62%, STEMI 44%; P < .001). Patients with MMD and NSTEMI were older than patients with STEMI or UA, had more comorbid conditions (diabetes, prior myocardial infarction, congestive heart failure), and were less likely to receive aspirin, unfractionated heparin, or revascularization therapies during the index hospitalization. After multivariable adjustment for all significant covariates, mortality increased sequentially along the spectrum of ACS (hazards ratios for UA 1.0 [referent], MMD 1.12 [95% CI 0.84-1.49], NSTEMI 1.28 [0.95-1.72], and STEMI 1.52 [1.06-2.19]).

CONCLUSIONS

Patients presenting with MMD and definite NSTEMI had a worse unadjusted long-term prognosis up to 10 years after index hospitalization than patients with STEMI. This mortality excess for MMD/NSTEMI was associated with more comorbid conditions and decreased use of basic therapies for ACS. After controlling for baseline differences, STEMI patients had the highest mortality.

Authors+Show Affiliations

Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

16644337

Citation

Allen, Larry A., et al. "Comparison of Long-term Mortality Across the Spectrum of Acute Coronary Syndromes." American Heart Journal, vol. 151, no. 5, 2006, pp. 1065-71.
Allen LA, O'Donnell CJ, Camargo CA, et al. Comparison of long-term mortality across the spectrum of acute coronary syndromes. Am Heart J. 2006;151(5):1065-71.
Allen, L. A., O'Donnell, C. J., Camargo, C. A., Giugliano, R. P., & Lloyd-Jones, D. M. (2006). Comparison of long-term mortality across the spectrum of acute coronary syndromes. American Heart Journal, 151(5), 1065-71.
Allen LA, et al. Comparison of Long-term Mortality Across the Spectrum of Acute Coronary Syndromes. Am Heart J. 2006;151(5):1065-71. PubMed PMID: 16644337.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of long-term mortality across the spectrum of acute coronary syndromes. AU - Allen,Larry A, AU - O'Donnell,Christopher J, AU - Camargo,Carlos A,Jr AU - Giugliano,Robert P, AU - Lloyd-Jones,Donald M, PY - 2004/12/10/received PY - 2005/05/14/accepted PY - 2006/4/29/pubmed PY - 2006/5/27/medline PY - 2006/4/29/entrez SP - 1065 EP - 71 JF - American heart journal JO - Am Heart J VL - 151 IS - 5 N2 - BACKGROUND: Data are sparse regarding comparative long-term mortality across the spectrum of patients presenting with acute coronary syndrome (ACS). METHODS: We identified all patients hospitalized with suspected myocardial ischemia in an urban academic hospital from 1991 to 1992. We compared presenting characteristics, treatment, and long-term mortality between patients with unstable angina (UA), minor myocardial damage (MMD), definite non-ST-elevation myocardial infarction (NSTEMI), and STEMI. RESULTS: Of 760 patients (mean age 68 years, 35% women), 22% had UA, 35% had MMD, 26% had NSTEMI, and 17% had STEMI. During a mean follow-up of 9.5 years, unadjusted mortality was highest in patients with MMD and NSTEMI (mortality for UA 43%, MMD 68%, NSTEMI 62%, STEMI 44%; P < .001). Patients with MMD and NSTEMI were older than patients with STEMI or UA, had more comorbid conditions (diabetes, prior myocardial infarction, congestive heart failure), and were less likely to receive aspirin, unfractionated heparin, or revascularization therapies during the index hospitalization. After multivariable adjustment for all significant covariates, mortality increased sequentially along the spectrum of ACS (hazards ratios for UA 1.0 [referent], MMD 1.12 [95% CI 0.84-1.49], NSTEMI 1.28 [0.95-1.72], and STEMI 1.52 [1.06-2.19]). CONCLUSIONS: Patients presenting with MMD and definite NSTEMI had a worse unadjusted long-term prognosis up to 10 years after index hospitalization than patients with STEMI. This mortality excess for MMD/NSTEMI was associated with more comorbid conditions and decreased use of basic therapies for ACS. After controlling for baseline differences, STEMI patients had the highest mortality. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/16644337/Comparison_of_long_term_mortality_across_the_spectrum_of_acute_coronary_syndromes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(05)00520-X DB - PRIME DP - Unbound Medicine ER -